Medicaid Contract Decision Spurs Court Fight

Aug 23, 2018

A dispute over the the state Agency for Health Care Administration’s decision to award a Medicaid managed-care contract in Southwest Florida has turned into a court battle.

Best Care Assurance, LLC, a managed-care plan affiliated with the Lee Health system, has filed a lawsuit in Leon County circuit court arguing that state officials improperly awarded a contract in June to a competing managed-care plan, Molina Healthcare of Florida., Inc.

The lawsuit, filed Friday, is part of a series of legal disputes that have stemmed from the Agency for Health Care Administration’s decisions this spring to award tens of billions of dollars in contracts to managed-care plans to serve Medicaid patients throughout the state.

Best Care Assurance was one of four plans awarded contracts in April to serve patients in the Medicaid system’s Region 8, which is made up of Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. Molina was not one of the four plans and filed a protest. It ultimately reached a settlement in June with agency officials that included it receiving a contract in the region.

In the lawsuit, Best Care Assurance argues, in part, that the decision was improper because state law imposes a limit of four managed-care plans in the region to provide “managed medical assistance” services --- the services provided to most Medicaid beneficiaries. The other plans selected in April to provide such services in the region were Humana Medical Plan, Inc., Sunshine State Health Plan, Inc. and WellCare of Florida, Inc., the lawsuit said.

“The Legislature did not accidentally place a cap on the number of MMA (managed medical assistance) plans to be selected in Region 8,” the lawsuit said. “Rather, the Legislature specifically set the allowable range for the number of MMA plans to be selected in Region 8 to ensure stability but allow patient choice. AHCA’s actions ignore the legislative mandate, as well as the significant negative consequences to Best Care and the MMA program overall in Region 8 resulting from AHCA’s action.”

Best Care also tried to fight the Molina contract award through a challenge in the state Division of Administrative Hearings. But in an Aug. 3 ruling, Administrative Law Judge Linzie Bogan said Best Care did not have legal standing to challenge the agency decision to award a contract to Molina or to argue that the contract violates state law.

Bogan said Best Care didn’t intervene in Molina’s underlying protest after the April contract awards and that, as a result, Best Care did not establish standing. Best Care has filed a motion to reopen the administrative case, but Molina filed a document Aug. 16 objecting to that request.

“In the end, Best Care simply failed to intervene in Molina’s protest proceeding and therefore waived any right Best Care contends it has to challenge Molina’s settlement with AHCA and the resulting contract award to Molina,” said the Molina document, which was joined by the Agency for Health Care Administration.

Florida lawmakers in 2011 approved an overhaul of the Medicaid system that has led to most beneficiaries enrolling in managed-care plans. With an initial set of contracts poised to expire, the Agency for Health Care Administration went through a lengthy procurement process that led in April to it awarding new contracts in 11 regions of the state.